Providers
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Provider Manual
Your source for commonly asked questions about healthcare coverage, claims procedures, policies and more.
View Provider ManualHealth Information Network (HIN)
Provides access to patient information including demographics, eligibility and benefits, claims, claim submission, claim correction, claim status, remittance advices, fee schedules, and more.
Learn more about HINCoverage policy
Quickly search for coverage information using a keyword, procedure code, policy number or title.
View coverageInterQual® Coverage Policy Guidelines
The InterQual® guidelines are used by our utilization management team to help assess whether a given medical condition and known or represented circumstances of a case support medical service(s) as the most appropriate treatment, or whether the medical condition/circumstances presented could be appropriately addressed with an alternative treatment. Use the self-registration tool at the link to create a login and view the criteria. Individuals without an email address should contact the plan to receive the criteria information via mail.
Please consult your provider for applicable policies and/or criteria.
BlueCard® program
A program linking providers across the country into a single electronic network for claims processing and reimbursement.
Learn about BlueCardValue-based programs
Learn more about our value-based care program, which rewards providers for coordinating care and for positive health outcomes.
View value-based careBlue Distinction Centers
The Blue Distinction program highlights medical facilities demonstrating expertise in delivering quality healthcare.
View Blue Distinction CentersTotal Care
Total Care recognizes doctors that focus on health care instead of sick care. Total Care is coordinated, patient-focused and, in many cases, more affordable healthcare.
Learn more about Total CarePrior approval statistics
See our prior approval statistics for each quarter for medical, pharmacy and transplants.
View statsNetwork participation guidelines
Access network participation guidelines and policies for credentialing standards.
View guidelinesNetwork development reps (NDRs)
Contact one of our medical network representatives with questions or billing issues.
Contact NDRsMedicare Network Specialists
Contact a dedicated representative with questions or billing issues related to Medicare networks.
Contact a specialistMy BlueLine
Participating providers may call My BlueLine for eligibility, claim status and benefit information for patients.
Contact My BlueLinePrior Authorization Code Lookup
A tool for providers to check if a procedure code is required for a specific group.
Look up Prior Authorization CodesPrior authorization for requested services
The primary coverage criteria of certain services must be established through a prior approval or pre-authorization process before they can be performed.
Learn more about prior authorization